Delirium Flashcards
Define delirium
acute confusional state with fluctuating course and disturbance in cognitive function and consciousness of perception
Is there usually a single cause for delirium
NO, the cause is multifactorial
Over what time frame does delirium develop
Short term - hours to days
Why is it important to recognise delirium early
Because it can lead to increased hospital stay, HAI, and increased risk of death
What can delirium be a sign of
atypical symptom of infection
What are patients at increased risk of if they develop delirium
dementia
what is the pathophysiology behind delirium
direct toxic insult to the brain eg hypoxia, drugs, low glucose+Na
Abnormal stress response
Variable derangement of certain neurotransmitters (ACh)
List some predisposing factors for delirium
Advanced age Co-morbidities pre-existing dementia terminal illness post-op period malnutrition alcohol excess sensory impairment polypharmacy depression
What are some precipitants of delirium
medications hypoxia alcohol biochemical imbalances infection urinary retention catheters dehydration constipation
Hallmarks of delirium
acute and fluctuating
inattention
disorganised thinking
altered consciousness
Name and describe the types of delirium
HYPERactive - agitated, aggressive, wandering
HYPOactive - drowsy, bed bound, quiet
Which type of delirium has a higher risk of mortality
HYPOactive - because it goes unnoticed for longer
What are the tools to look for delirium
4AT and Confusion Assessment Method (CAM)
Describe the 4AT tool
What score suggests delirium
4A's Alert AMT4 - name DOB place and current year Attention - list months of year backwards Acute >4/12 --> delirium
Describe the CAM tool
Feature 1 - acute and fluctuating 2 - inattention 3 - disorganised thinking 4 - altered consciousness delirium = 1+2+3/4
How do you manage delirium
identify and reverse all underlying causes symptom control ideally non-pharmacologically review and follow up consider capacity assessment
What are the non-pharmacological options for managing delirium
calm environment same staff glasses, hearing aids hydrate solve constipation mobilise sleep chart food and fluid chart clocks and calendars reassure patient and family
What are the pharmacological options for managing delirium
Only use sedative medications if the patient is a danger to themselves or others and DOCUMENT why it was given
Also antibiotics can be given if infection
1st line - haloperidol
- high potency
- give PO
- few anticholinergic side effects
- AVOID in Parkinsons
2nd line - benzodiazepines (lorazepam)
- use in alcohol withdrawal or if haloperidol is contra-indicated
- sedative effect and increases risk of falls
- may worsen delirium in some cases
What is important that you must do after resolving delirium
Follow up patient to look out for dementia
